NPI 1235315516

Lakeside Medical Wellness Clinic

Organisation Preferred Provider Organization Sulphur, LA

Practice location

Address: 110 E Darbonne St STE B, Sulphur, LA 70663-4958
Phone: (337) 527-9529
Fax: (337) 527-5049

Authorised official

Name: George E Smith
Title: Owner
Phone: (337) 527-9529

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1235315516
Entity type: Organization
NPI issued: 16 Jan 2008
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.